Provider First Line Business Practice Location Address:
6855 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
SUITE A105
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-572-2128
Provider Business Practice Location Address Fax Number:
509-572-2146
Provider Enumeration Date:
04/30/2015